Healthcare Provider Details

I. General information

NPI: 1679410260
Provider Name (Legal Business Name): MAKAYLA GARRETT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 RENATO CT STE D
REDWOOD CITY CA
94061-4017
US

IV. Provider business mailing address

161 S 39TH ST
RICHMOND CA
94804-3350
US

V. Phone/Fax

Practice location:
  • Phone: 714-257-5534
  • Fax:
Mailing address:
  • Phone: 707-914-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: